CE-MRV融合颅脑三维成像在儿童难治性癫痫外科中的应用
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摘要
目的利用磁共振颅脑三维(3DMRI)及增强静脉成像(CE-MRV)导入神经导航系统获取患者脑表面血管三维立体脑电图,用以精确定位颅内致痫灶并指导外科手术治疗,观察其在儿童药物难治性癫痫患儿治疗中的准确性、安全性及有效性。方法我院神经外科2016年3月至2017年10月收治的22例药物难治性癫痫患者行颅脑3D-MRI及CE-MRV,利用StealthViz?神经导航系统融合影像数据,进行脑组织分割,建立立体大脑及皮层静脉模型,设计路径避开血管,在该立体定向系统下植入电极,术后长程视频脑电监测颅内致痫灶,并对有手术指征患者进行手术切除,术后对患者进行随访,分析其准确性、安全性及有效性。结果 22例患者三维立体图像效果均较好,皮层静脉均显示清楚,手术所有电极均成功植入,共植入电极143枚,所有患儿均未出现出血及感染等并发症,出血发生率0%,其中一例行二次手术补置电极一根,亦无并发症发生。所有病例术后进行视频脑电监测,确定颅内致痫灶并进行手术,术后随访疗效满意。结论应用磁共振颅脑3D-MRI及CEMRV成像建立立体大脑及皮层静脉模型能有效避免电极植入出血;立体定向电极植入作为儿童药物治疗难治性癫痫的方法是准确、安全、有效的。
Objective To observe the accuracy, safety and efficacy of pinpointing intracranial epileptogenic lesions and guiding surgical treatment of children with refractory epilepsy by using 3 D-MRI of cranial brain and venous MRI with contrast enhancement(CE-MRV) into the neural navigation system to form three-dimensional stereoelectroencephalography(SEEG). Methods 22 cases of refractory epilepsy from Mar 2016 to Oct 2017 in our hospital underwent cranial brain 3 D-MRI and CE-MRV, which input in StealthViz? neural navigation system to establish stereotactic 3 D brain and cortical vein model. Electrodes were implanted and all the brain surface vessels were avoided because of well-designed surgical path under this system. SEEG operations were performed on all patients with surgical indications after intracranial epileptogenic lesions were monitored by long-term video EEG. All patients were followed up after operation to analyze their accuracy, safety and effectiveness. Results 3 D-MRI and CE-MRV images of 22 patients were shown clearly, all the electrodes were successfully implanted, A total of 143 electrodes were implanted, none of the cases had complications of bleeding and infection,and the incidence of bleeding was 0%, only one of them was implanted with an electrode in a second operation, and no complications occurred as well. All patients intracranial epileptogenic lesions were localized and removed after monitored by video EEG. Followup effect in all patients were satisfactory. Conclusion Using 3 D-MRI of cranial brain and CE-MRV to establish stereoscopic cerebral and cortical venous model can effectively prevent electrode implantation bleeding; SEEG implantation as an invasive method of pre-operation evaluation in refractory epilepsy patients of children is accurate, safe and effective.
Objective To observe the accuracy, safety and efficacy of pinpointing intracranial epileptogenic lesions and guiding surgical treatment of children with refractory epilepsy by using 3 D-MRI of cranial brain and venous MRI with contrast enhancement(CE-MRV) into the neural navigation system to form three-dimensional stereoelectroencephalography(SEEG). Methods 22 cases of refractory epilepsy from Mar 2016 to Oct 2017 in our hospital underwent cranial brain 3 D-MRI and CE-MRV, which input in StealthViz? neural navigation system to establish stereotactic 3 D brain and cortical vein model. Electrodes were implanted and all the brain surface vessels were avoided because of well-designed surgical path under this system. SEEG operations were performed on all patients with surgical indications after intracranial epileptogenic lesions were monitored by long-term video EEG. All patients were followed up after operation to analyze their accuracy, safety and effectiveness. Results 3 D-MRI and CE-MRV images of 22 patients were shown clearly, all the electrodes were successfully implanted, A total of 143 electrodes were implanted, none of the cases had complications of bleeding and infection,and the incidence of bleeding was 0%, only one of them was implanted with an electrode in a second operation, and no complications occurred as well. All patients intracranial epileptogenic lesions were localized and removed after monitored by video EEG. Followup effect in all patients were satisfactory. Conclusion Using 3 D-MRI of cranial brain and CE-MRV to establish stereoscopic cerebral and cortical venous model can effectively prevent electrode implantation bleeding; SEEG implantation as an invasive method of pre-operation evaluation in refractory epilepsy patients of children is accurate, safe and effective.
引文
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[11]陈韵,周永红,陈东,等.MRV在矢状窦旁脑膜瘤术前评估中的应用价值[J].中国CT和MRI杂志,2011,9(3):14-16.
[12]Guenot M,Isnard J,Ryvlin P,et al. Neurophysiological monitoring for epilepsy surgery:the Talairach SEEG method.StereoElectroEncephaloGraphy.Indications, results,complications and therapeutic applications in a series of 100consecutive cases[J]. Stereotact Funct Neurosurg, 2001, 77(1-4):29-32.
[13]李文玲,郭涛,董长征,等.立体脑电图在药物难治性癫痫术前评估中的应用(附九例报告)[J].中华神经外科杂志,2014, 30(1):3-8.
[14]王昌泉,徐纪文,周洪语,等.基于导航的立体定向脑电图在癫痫外科中的应用[J].立体定向和功能性神经外科杂志,2015, 28(3):129-133.
[2] Centeno RS, Yacubian EM,Caboclo LO,et al. Intracranial depth electrodes implantation in the era of image-guided surgery[J]. Arquivos de NeuroPsiquiatria,2011,69(4):693-698.
[3] Gonzalez-Mart inez J,Bulacio J,Alexopoulos A,et al. Stereoelect roencephalography in the"difficult to localize"refractory focal epilepsy:early experiencefrom a a North American epilepsy center[J].Epilepsia, 201 3, 54(2):323-330.
[4] Panz ica,F,Varot to G, Rorond i F,et al.Identificat ion of the Epileptogenic Zone from StereoEEG Signals:A Connectivity Graph Theory Approach[J]. Front Neurol, 2013, 4:175.
[5]蔡立新.儿童难治性癫痫手术适应证及手术时机选择[J].中国实用儿科杂志,2016, 31(1):31-36.
[6] Johns ton JM Jr, Mangano FT,Ojemann JG,et al. Complications of invasive subdural electrode monitoring at St.Louis Children's Hospital,1994-2005[J]. J Neurosurg, 2 006, 105(5Suppl):343-347.
[7] Crandall PH, Walter RD, Rand RW.Clinical applications of studies on s tereotact ically implanted electodes in temporal lobe epi lepsy[J].J Neurosurg,1963, 20:827-840
[8] Cossu M,Lo Russo G,Francione S,et al. Epilepsy surgery in children:results and predictors of outcome on seizures[J].Epi leps ia, 2008, 49(1):65-72.
[9] Cardina 1eF,Cossu M, Castana L,et al.StereoElectroEncephaloGraphy:Surgical Methodology, Safetyand Stereotactic Application Accuracy in Five Hundred Procedures[J].Neurosurgery,2013, 72(3):353-366.
[10]马银华,史强.脑静脉(窦)血栓形成的MRI和MRV诊断价值[J].中国CT和MRI杂志,2014, 12(1):36-38.
[11]陈韵,周永红,陈东,等.MRV在矢状窦旁脑膜瘤术前评估中的应用价值[J].中国CT和MRI杂志,2011,9(3):14-16.
[12]Guenot M,Isnard J,Ryvlin P,et al. Neurophysiological monitoring for epilepsy surgery:the Talairach SEEG method.StereoElectroEncephaloGraphy.Indications, results,complications and therapeutic applications in a series of 100consecutive cases[J]. Stereotact Funct Neurosurg, 2001, 77(1-4):29-32.
[13]李文玲,郭涛,董长征,等.立体脑电图在药物难治性癫痫术前评估中的应用(附九例报告)[J].中华神经外科杂志,2014, 30(1):3-8.
[14]王昌泉,徐纪文,周洪语,等.基于导航的立体定向脑电图在癫痫外科中的应用[J].立体定向和功能性神经外科杂志,2015, 28(3):129-133.